title: Transluminal balloon angioplasty for symptomatic distal vasospasm refractory to medical therapy in patients with aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Cerebral vasospasm (VSP) is a major cause of morbidity and mortality associated with subarachnoid hemorrhage. The current endovascular paradigm for VSP refractory to medical therapy is to perform angioplasty for proximal vessel VSP and vasodilator infusion for distal vessel VSP.
  
  
  OBJECTIVE
  To report our experience with a large series of balloon angioplasty for distal VSP refractory to medical therapy in patients with aneurysmal subarachnoid hemorrhage.
  
  
  METHODS
  This was a retrospective series of 32 patients with subarachnoid hemorrhage and symptomatic VSP refractory to medical therapy who were treated with balloon angioplasty for distal vessel VSP. Immediate angiographic results, procedure-related complications, and clinical outcomes were assessed.
  
  
  RESULTS
  From September 2001 to January 2010, 32 patients with symptomatic VSP refractory to medical therapy underwent angioplasty for distal arterial VSP. There were 26 women (81.3%); patients were 29 to 67 years of age. A total of 175 vessels were angioplastied (95 proximal and 80 distal). The only complication was rupture of an incompletely clipped aneurysm that was treated by immediate coiling and did not result in any clinical worsening. Repeated treatment was needed for 6 arteries (6 of 80, 7.5%). There were no procedure-related symptomatic complications. Good outcomes (modified Rankin Scale score ≤ 2) were observed in 23 of 28 patients (82.1%) with follow-up.
  
  
  CONCLUSIONS
  Balloon angioplasty for distal VSP is safe and effective and decreases the need for repeated intraarterial treatments seen with infusion of vasodilator.
authors.affiliation: Division of Interventional Neuroradiology, Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, New York 10065, USA. als2052@med.cornell.edu
authors.forename: Alejandro
authors.initials: A
authors.lastname: Santillan
authors.forename: Jared
authors.initials: J
authors.lastname: Knopman
authors.forename: Walter
authors.initials: W
authors.lastname: Zink
authors.forename: Athos
authors.initials: A
authors.lastname: Patsalides
authors.forename: Y Pierre
authors.initials: YP
authors.lastname: Gobin
mesh_terms: D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000379:methods*; D000800:Angioplasty, Balloon / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D016896:Treatment Outcome; D014664:Vasodilation; D020301:Vasospasm, Intracranial / Q000209:etiology*